Original articleProstate MRI: Access to and Current Practice of Prostate MRI in the United States
Introduction
The American Cancer Society estimates that there will be 241,740 new cases of prostate cancer in 2012, ranking in incidence behind only skin cancer [1]. Although approximately 28,170 men will die of prostate cancer in 2012, an almost 100% 5-year survival can be achieved if diagnosis is made at an early stage [2]. Worldwide, MRI is increasingly performed in the diagnosis and staging of prostate cancer. Despite the growing utilization of prostate MRI, it is not a standard procedure performed at all institutions in the United States. There is also wide variability among the methods and protocols in which prostate MRI is performed. For example, in addition to standard MR T1- and T2-weighted imaging, dynamic contrast enhanced imaging (DCE), MR spectroscopy (MRS), and diffusion-weighted imaging (DWI) methods are frequently performed. There is extensive literature on the accuracy of these techniques [3, 4, 5, 6]. Debate is ongoing related to the MRI field strength and endorectal coil requirements for these studies [2, 6, 7, 8, 9, 10]. The initial indication for prostate MRI was for cancer staging and to evaluate the presence of extracapsular extension and seminal vesicle invasion [11]. The indications for prostate MRI have shifted towards searching for “missed tumors” in patients with prior negative biopsies, planning biopsy targeting, planning radiation, and selecting patients for active surveillance [3, 6].
Recently, the European Society of Urogenital Radiology (ESUR) developed prostate MRI recommendations based on consensus expert opinions, with minimal and optimal requirements [7, 8]. Unlike other imaging techniques in the United States, there is not a definitive and universal protocol for prostate MRI. Also, although best practice guidelines may exist, many practices throughout the United States may not follow this standard. This survey was undertaken to determine the access and practice of prostate MRI amongst academic, private practice, and community groups throughout the United States.
Section snippets
Methods
This study was approved by the institutional review board. A brief online survey was created to achieve the study objectives of determining access to prostate MRI and the commonly performed protocols. An e-mail invitation to participate in this electronic survey was sent through the Society of Abdominal Radiology and the Texas Radiological Society mailing lists. The survey questions are listed in Appendix 1. Institutional affiliation was collected to determine duplicate responses. If physicians
Results
A total of 66 responses were received from the survey within 30 days of the initial request. There were 9 duplicate responses and 6 responses from international institutions. A total of 51 responses from separate United States institutions remained after eliminating duplicates. Responses were received from 40 academic radiology groups (36 United States), 5 large private practice groups (5 United States), and 12 community groups (10 United States). As there are 109 academic radiology practices
Discussion
Prostate MRI has been described since the early 1980s. The technique is receiving increased attention both clinically and in the development of new techniques. Despite the adoption of prostate MRI into clinical practice, a standard-of-care for prostate MRI does not appear to have developed in the United States. Recently, in attempt to provide direction to groups performing prostate MRI, the ESUR developed recommendations for minimum and optimal prostate performance based on expert opinion and
Take-Home Points
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Prostate MRI is increasingly being performed for the clinical care of men with prostate cancer.
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The majority of surveyed academic institutions now perform prostate MRI.
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Although there remains variability in the practice of prostate MRI, there are common MRI equipment expectations and MRI protocols that are ubiquitous among practices.
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The minority of centers are performing prostate cancer MRI on a regular basis with adequate numbers. This may have a negative effect on quality.
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Sections of
Acknowledgments
We thank the Society of Abdominal Radiology and the Texas Radiological Society for distributing this survey among their members. Funding support received in part from the Cancer Center Support Grant P30CA054174 from the National Cancer Institute.
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2020, Clinical RadiologyCitation Excerpt :In a brief electronic survey evaluating the utilisation of MRI for prostate cancer in institutions across USA, it was found that there was marked variation in the magnet field strength and the use of an ERC in these institutions.18 Nearly 30% of the academic institutions perform prostate MRI at 1.5 T with an ERC, 30% at 3 T with an ERC and 30% at 3 T without an ERC while none of the private practice or community groups used an ERC even with 1.5 T magnet strength.18 The necessity of an ERC for prostate MRI remains controversial.
Dr Rulon Hardman reports a CPRIT Texas Cancer training grant.